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Questões éticas na cirurgia da surdez
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Desde que, no século passado, os primeiros implantes cocleares foram colocados, começaram a levantar-se algumas questões éticas relativamente à sua utilização. Este artigo revê a literatura em relação a estas questões com o objetivo de perceber quais são, atualmente, os critérios éticos que devem reger a melhores práticas no que toca à cirurgia da surdez.
Para levar a cabo este objetivo analisei aquelas que me pareceram as quatro principais questões éticas que se levantam neste contexto, nomeadamente a questão da eficácia do implante coclear, a questão monetária que subjaz a esta dispendiosa cirurgia, a questão sociocultural, que apõe visões diferentes da surdez e por fim a questão do consentimento informado, tão importante quando sabemos que uma grande parte dos utilizadores desta cirurgia serão crianças.
Este estudo começa por estabelecer a elevada eficácia do implante coclear na melhoria das funções cognitivas e qualidade de vida no geral para passar a mostrar que o rádio custo-eficácia justifica sua utilização unilateral precoce, por questões de justiça distributiva em contexto de recursos limitados. Conclui-se sobre a necessidade de aprendizagem de língua gestual posterior à cirurgia. Mostra-se também a necessidade de um equilíbrio de uma visão médica com a visão da comunidade surda no consentimento informado para seja garantida uma escolha livre.
Se de um ponto de vista tecnológico a cirurgia da surdez está sobejamente justificada, cada vez se torna mais importante o papel do médico, não só na questão técnica mas sobretudo na questão da decisão, da alocação dos recursos e do correto e imparcial aconselhamento e esclarecimento dos doentes.
Since the first cochlear implants were placed in the last century, some ethical questions have been raised regarding their use. This article reviews the literature in relation to this issues in order to understand what are, at present, the ethical criteria that should govern best practices with regard to deafness surgery. In order to carry out this objective, I analyzed those that seemed to me to be the four main ethical questions that arise in this context, namely the question of the effectiveness of the cochlear implant, the monetary issue that underlies this expensive surgery, the socio-cultural issue, which oppose different points of view of deafness and finally the issue of informed consent, so important when we know that a large part of the users of this surgery will be children. This study begins by establishing the high effectiveness of the cochlear implant in improving cognitive functions and quality of life in general, to show that the cost-effective ratio justifies its early unilateral use, for reasons of distributive justice in the context of limited resources. It also concludes the need to learn sign language after surgery. It also shows the need to balance a medical view with the view of the deaf community in informed consent to guarantee free choice. If, from a technological point of view, deafness surgery is quite justified, the role of the physician is becoming increasingly important, not only in the technical question but above all in the question of decision, allocation of resources and correct and impartial advice and clarification of patients.
Since the first cochlear implants were placed in the last century, some ethical questions have been raised regarding their use. This article reviews the literature in relation to this issues in order to understand what are, at present, the ethical criteria that should govern best practices with regard to deafness surgery. In order to carry out this objective, I analyzed those that seemed to me to be the four main ethical questions that arise in this context, namely the question of the effectiveness of the cochlear implant, the monetary issue that underlies this expensive surgery, the socio-cultural issue, which oppose different points of view of deafness and finally the issue of informed consent, so important when we know that a large part of the users of this surgery will be children. This study begins by establishing the high effectiveness of the cochlear implant in improving cognitive functions and quality of life in general, to show that the cost-effective ratio justifies its early unilateral use, for reasons of distributive justice in the context of limited resources. It also concludes the need to learn sign language after surgery. It also shows the need to balance a medical view with the view of the deaf community in informed consent to guarantee free choice. If, from a technological point of view, deafness surgery is quite justified, the role of the physician is becoming increasingly important, not only in the technical question but above all in the question of decision, allocation of resources and correct and impartial advice and clarification of patients.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Palavras-chave
Ética Surdez Implantes cocleares Comunidade surda Otorrinolaringologia